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RESUMO
No ano 2030, o número de indivíduos acima de 65 anos pode alcançar 70 milhões
somente nos Estados Unidos; o segmento populacional que mais cresce é o de pessoas com
85 anos e mais. Como mais indivíduos vivem mais, é necessário determinar a amplitude e os
mecanismos em que o exercício e a atividade física podem melhorar a saúde, capacidade
funcional, qualidade de vida e independência nesta população. O envelhecimento é um
processo complexo que envolve muitas variáveis (por exemplo, genética, estilo de vida,
doenças crônicas) que interagem entre si e influenciam significativamente o modo em que
alcançamos determinada idade. A participação em atividade física regular (exercícios
aeróbicos e de força) fornecem um número de respostas favoráveis que contribuem para o
envelhecimento saudável. Muito tem sido aprendido recentemente em relação à
adaptabilidade dos vários sistemas biológicos, assim como os meios em que o exercício
regular pode influenciá-los.
A participação em um programa de exercício regular é uma modalidade de
intervenção efetiva para reduzir/prevenir um número de declínios funcionais associados ao
envelhecimento. Adicionalmente, a treinabilidade dos indivíduos idosos (incluindo octo- e
nonagenarianos) é evidenciada pela habilidade de se adaptarem e responderem a ambos
tipos de treinamento, endurance e força. O treinamento de endurance pode ajudar a manter
e melhorar vários aspectos da função cardiovascular (VO2máx, débito cardíaco e diferença
arterio-venosa de O2) bem como incrementar a performance submáxima. Muito importante,
as reduções nos fatores de risco associados com os estados de doença (doença cardíaca,
diabetes, etc.) melhoram o estado de saúde e contribuem para o incremento na expectativa
de vida. O treinamento de força ajuda a compensar a redução na massa e força muscular
tipicamente associada com o envelhecimento normal. Benefícios adicionais do exercício
regular incluem melhora da saúde óssea, portanto, redução no risco de osteoporose;
melhora da estabilidade postural, reduzindo assim o risco de quedas, lesões e fraturas
associadas; e incremento da flexibilidade e amplitude de movimento. Enquanto, somente
algumas evidências sugerem que o envolvimento em exercícios regulares pode também
fornecer muitos benefícios psicológicos relacionados a preservação da função cognitiva,
alívio dos sintomas de depressão e comportamento, e uma melhora no conceito de controle
pessoal e auto-eficácia. É importante observar que não necessariamente a participação em
atividades físicas pode demonstrar incrementos nos marcadores fisiológicos tradicionais de
performance e aptidão física (por exemplo, VO2máx, capacidade oxidativa mitocondrial,
composição corporal) em pessoas idosas, mas melhora a saúde (redução nos fatores de
risco de doenças) e capacidade funcional. Portanto, os benefícios associados à atividade
física e o exercício regular contribuem para um estilo de vida independente e mais saudável,
melhorando muito a capacidade funcional e a qualidade de vida nesta população.
INTRODUÇÃO
FUNÇÃO CARDIOVASCULAR
TREINAMENTO DE FORÇA
Estabilidade Postural
Estudos utilizando quedas como medida. Enquanto muitos estudos têm examinado os
efeitos do exercício sobre a estabilidade postural, somente poucos investigadores continuam
examinando o subsequente efeito sobre a frequência de quedas na vida diária. A
participação em programas de exercício de intensidade leve tem demonstrado reduzir
significativamente o número de quedas comparado aos grupos controle que não realizam
exercícios, com o grupo de exercícios não experimentando nenhuma lesão por queda que
necessite de atenção médica (130, 229, 244).
Em uma meta-análise de sete projetos FICSIT (182), que examinaram o papel do
exercício em idosos frágeis, foi atribuído a um grupo de exercícios decréscimo no risco de
quedas, indicando um efeito benéfico total do tratamento com exercícios. Os diferentes
tratamentos foram, entretanto, extremamente variados em sua natureza, e alguns incluíam
educação e outros componentes sem exercício.
Recomendações. Ainda existem muitas questões que devem ser respondidas referentes a
eficácia de diferentes formas de exercício como estratégias de prevenção de quedas em
diversos grupos de indivíduos idosos (34, 228). Devido a natureza multifacetária de vários
programas de intervenção, ainda não é possível identificar os mecanismos específicos em
que a estabilidade postural tem melhorado. Contudo, parece que existe uma evidência
suficiente que suporta a recomendação de um programa amplo de exercícios que inclua
treinamento de equilíbrio, exercício resistido, caminhada e transferência de peso, podem ser
inclusos como parte de uma intervenção multifacetária para reduzir os riscos de queda.
Enquanto a frequência e a intensidade ótima do programa permanecem incertas, existem
vários estudos que têm demonstrado efeitos positivos significantes na estabilidade postural
com uma variedade de intervenções.
Flexibilidade
FUNÇÃO PSICOLÓGICA
Treinamento do idoso frágil e muito idoso. Muitos estudos de grande escala sobre
exercício no idoso frágil ainda não foram publicados, mas os resultados dos experimentos
clínicos randomizados indicam que o ganho na força em resposta ao treinamento de
resistência de alta intensidade é mais dependente da intensidade do estímulo que das
características, idade ou estado de saúde do indivíduo. Como nos indivíduos jovens, aqueles
com fragilidade muscular mas com grandes reservas de tecido magro têm melhores
respostas, que é devido primariamente à adaptações neurais ao treinamento nos primeiros
três meses. Idade, sexo, condições crônicas específicas, depressão, demência, estado
nutricional e deterioração funcional não têm demonstrado que influenciam a adaptação ao
treinamento. Os dados sobre a capacidade aeróbica são muito menos claros, já que há
poucos dados disponíveis sobre as alterações fisiológicas após intervenções
cardiovasculares na pessoa muito idosa ou frágil (221).
Os princípios de especificidade que se aplicam ao adulto jovem são de igual
relevância no idoso frágil. Incremento na força e massa muscular são observados seguindo
treinamento de resistência progressiva de alta intensidade (80% de uma repetição máxima)
(64), enquanto protocolos de menor intensidade (peso corporal, banda ou tubo elástico,
resistência contra um terapeuta ou pesos leves) resultam em pouco, se algum, ganho
significativo na força (159). A debilidade e a atrofia muscular são provavelmente os
parâmetros mais relevantes funcionalmente e reversíveis relacionados ao exercício nesta
população. Portanto, os esforços para reverter estes déficits e minimizar as conseqüências
clínicas (declínio funcional, imobilidade, equilíbrio ruim, quedas e baixos requerimentos e
ingestão energética) podem focalizar sobre estratégias experimentadas cientificamente
preferivelmente que programas de “movimento” não específicos para a idade. Melhoras na
caminhada, velocidade, equilíbrio, habilidade para se levantar de uma cadeira, potência de
subir escadas, capacidade aeróbica, testes baseados em performance da independência
funcional, auto-reporte de desabilidade, disposição de sintomas depressivos e ingestão
energética (63-65, 165, 183, 196) são associados com ganhos na força após treinamento de
força no idoso frágil. Em sujeitos idosos saudáveis, o treinamento de força mantêm ou
incrementa a densidade óssea, taxa metabólica de repouso, sensibilidade a insulina, tempo
de trânsito gastro-intestinal e decréscimo nas dores e desabilidade da artrite, reduz a
adiposidade corporal e central, e melhora a qualidade de sono, mas isto permanece para ser
verificado se estas adaptações também ocorrem no idoso muito frágil.
Intervenções de exercício aeróbico de alta intensidade não têm sido descritos em
populações idosas frágeis. Atividades aeróbicas de baixa intensidade, tais como caminhada,
estar em pé e ciclismo estacionário a 60% da frequência cardíaca máxima predita, têm sido
associadas com melhoras modestas na eficiência cardiovascular (162, 221) e tarefas de
mobilidade, como por exemplo, caminhada e levantar-se de uma cadeira (197). Isto pode ser
notado, contudo, que o custo energético das atividades para o idoso frágil com equipamentos
de ajuda (tais como andadores e cadeiras de roda), deformidades articulares e desordens de
caminhada, podem ser significativamente maiores que equações padronizadas deveriam
predizer e, com isso, até estudos utilizando calorimetria indireta para monitores de esforço
assim como a alteração de documentos são registrados nesta população, a magnitude exata
dos benefícios fisiológicos do treinamento aeróbico permanecem incertos. Isto é
provavelmente, embora que, como em adultos jovens, atividades aeróbicas de baixa
intensidade podem fornecer benefícios em termos de qualidade de vida, conseqüências
psicológicas e alívio de dores e desabilidade sem alteração substantivamente no
condicionamento cardiovascular.
CONCLUSÕES
Várias conclusões podem ser feitas através das evidências disponíveis. A participação
em um programa de exercício regular é uma modalidade de intervenção efetiva para
reduzir/prevenir um número de declínios funcionais associados ao envelhecimento.
Adicionalmente, a treinabilidade dos indivíduos idosos (incluindo octo- e nonagenarianos) é
evidenciada pela habilidade de se adaptarem e responderem a ambos os tipos de
treinamento, endurance e força. O treinamento de endurance pode ajudar a manter e
melhorar vários aspectos da função cardiovascular (VO2máx, débito cardíaco e diferença
arterio-venosa de O2) bem como incrementar a performance submáxima. Muito importante,
as reduções nos fatores de risco associados com os estados de doença (doença cardíaca,
diabetes, etc.) melhoram a condição de saúde e contribuem para o incremento na
expectativa de vida. O treinamento de força ajuda a compensar a redução na massa e força
muscular tipicamente associada ao envelhecimento normal. Simultaneamente, estas
adaptações ao treinamento melhoram muito a capacidade funcional das pessoas idosas,
desse modo melhorando a qualidade de vida nessa população. Benefícios adicionais do
exercício regular incluem melhora da saúde óssea, e então, decréscimo no risco de
osteoporose; melhora da estabilidade postural, reduzindo assim o risco de quedas, lesões e
fraturas associadas; e incremento da flexibilidade e amplitude de movimento. Enquanto,
algumas evidências também sugerem que o envolvimento em exercícios regulares pode
também fornecer vários benefícios psicológicos relacionados a preservação da função
cognitiva, alívio dos sintomas de depressão e comportamento, e uma melhora no conceito de
controle pessoal e auto-eficácia. Existe uma óbvia necessidade para mais pesquisas
conduzidas e corretamente controladas dedicando várias questões importantes relacionadas
a interação do exercício e atividade física no envelhecimento saudável. Isto inclui estudos
que variam desde investigações clínicas àqueles examinando os mecanismos celulares e
moleculares.
Simultaneamente, os benefícios associados ao exercício regular e a atividade física
contribuem para um estilo de vida independente e saudável, melhorando muito a capacidade
funcional e a qualidade de vida para o segmento de nossa população que cresce
rapidamente.
Este pronunciamento foi escrito para o American College of Sports Medicine por:
Robert S. Mazzeo, Ph.D. (FACSM), Peter Cavanagh, Ph.D., (FACSM), William J. Evans,
Ph.D. (FACSM), Maria A. Fiatarone, Ph.D., James Hagberg, Ph.D. (FACSM), Edward
McAuley, Ph.D. and Jill Startzell, Ph.D.
Este pronunciamento foi revisado para o American College of Sports Medicine pelos
seus maiores membros, o Comitê de Pronunciamento, e por John Lawler, Ph.D. e Christian
Leeuwenburg, Ph.D.
Desejamos agradecer às seguintes pessoas pela sua presteza neste posicionamento:
Doug Seals, Roger Enoka, Marjorie Woollacott e os membros do ACSM’s SHI sobre
Envelhecimento nas Ciências do Exercício e Medicina do Esporte.
Este Posicionamento foi traduzido para a Língua Portuguesa por Vagner Raso,
Membro Colaborador do CELAFISCS, e revisado por Victor K. R. Matsudo & Sandra M. M.
Matsudo, CELAFISCS.
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